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目的探讨经皮肾镜气压弹道联合超声碎石取石术治疗复杂性肾结石的疗效。方法全麻下经膀胱镜先向患侧逆行插入输尿管导管,俯卧位,在B超或X线引导下,向目标肾盏穿刺,建立皮肾通道,肾镜下用气压弹道联合超声腔内碎石机碎石取石。结果单通道取石137例,双通道取石11例,三通道取石2例;一次取石119例,二次取石27例,三次取石4例。手术时间(88±34)min。1例术后当晚发生感染性休克,经抗休克治疗后缓解;2例术后2周继发出血,保守治疗后缓解。术后3个月结石取净率为84.7%(127/150);23例残余结石中,术后10例行ESWL治疗,其中7例结石排净,余13例口服排石药,术后6个月随访结石排净率为89.3%(134/150)。结论经皮肾镜气压弹道联合超声碎石取石术治疗复杂性肾结石效率高,安全有效,损伤小,可以解决开放手术难以处理的复杂性肾结石。
Objective To investigate the effect of percutaneous nephrolithotracheal lithotripsy and ultrasonic lithotripsy in the treatment of complex renal calculus. Methods Under general anesthesia, cystoscopy was retrogradely inserted into the ureteral catheter and prone position in the affected side. Under the guidance of B-mode or X-ray, the renal calyces were punctured and the renal access was established. Pneumatic lithotripsy and intra-uterine ultrasound Stone rubble stone. Results Single-channel stone removal in 137 cases, double-channel stone in 11 cases, three-channel stone in 2 cases; 119 cases of stone, secondary stone 27 cases, three stone four cases. The operation time (88 ± 34) min. One patient developed septic shock on the night after surgery and was relieved after anti-shock treatment. Two patients developed secondary hemorrhage 2 weeks after operation and were relieved after conservative treatment. The stone removal rate was 84.7% (127/150) at 3 months after operation. Of the 23 residual stones, ESWL was performed in 10 patients after operation. Among them, 7 were discharged with stones and 13 were discharged with row of stone-forming drugs. Postoperative 6 The follow-up stone clearance rate was 89.3% (134/150). Conclusion Percutaneous nephroscope pneumatic lithotripsy combined with ultrasonic lithotripsy for the treatment of complicated nephrolithiasis is efficient, safe and effective with less damage and can solve the complicated renal calculi that is difficult to be treated by open surgery.